UHC Dual Complete WI-D001 (PPO D-SNP)

Available to residents of Lincoln County, WI for 2026. Contract H0294, plan 027, segment 0.

Renewed for 2026. CMS carries this plan forward from 2025.

Plan details

Monthly premium (Part C + D)	$9.00
— medical (Part C) part	$0.00
— drug (Part D) part	$9.00?
Monthly premium with full Extra Help (LIS)	$0.00?
Part B premium reduction (giveback)	None
In-network out-of-pocket maximum	$9,250.00?
In- and out-of-network out-of-pocket maximum	$13,900.00
Drug deductible	$615.00Tier 1 exempt
Drug out-of-pocket threshold	$2,100.00
Plan type	PPO D-SNP?
Special needs plan	Dual-eligible SNP
Contract / plan	H0294-027-0
Offered by	UnitedHealthcare
Parent organization	UnitedHealth Group, Inc.
Formulary drugs	3,609
Formulary exception tier	4?
Pharmacy search	UHC.com/Medicare
Member services	(888)834-3721TTY 711

CMS star ratings

Overall: 3.5 out of 5 stars for Overall
Health plan (Part C): 3.5 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 3 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H0294 shares this rating.

Plan health benefits

Service	In-network	Out-of-network?
Doctor visits
Primary care doctor	0%–20% coinsurance	30% coinsurance
Specialist	0%–20% coinsurance(authorization required)	30% coinsurance
Other health care professional	0%–20% coinsurance(authorization required)	30% coinsurance
Additional telehealth services	$0 copay	—
Preventive care
Medicare-covered preventive services	$0 copay	0%–40% coinsurance
Annual physical exam	$0 copay	40% coinsurance
Kidney disease education	$0 copay	40% coinsurance
Glaucoma screening	$0 copay	40% coinsurance
Diabetes self-management training	$0 copay	40% coinsurance
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	20% coinsurance(authorization required)	40% coinsurance
Lab services	$0 copay(authorization required)	$0 copay
Diagnostic radiology (e.g. MRI, CT)	0%–20% coinsurance(authorization required)	40% coinsurance
Therapeutic radiology	20% coinsurance(authorization required)	20% coinsurance
Outpatient x-rays	20% coinsurance(authorization required)	40% coinsurance
Emergency and urgent care
Emergency room	$115 copay	—
Urgent care	$0–$40 copay	—
Worldwide emergency coverage	$0 copay	—
Worldwide urgent care	$0 copay	—
Worldwide emergency transportation	$0 copay	—
Hospital care
Inpatient hospital stay	$1,830 per stay; $0 per day for days 91–999 (additional days)(authorization required)	$1,830 per stay
Outpatient hospital services	0%–20% coinsurance(authorization required)	40% coinsurance
Outpatient observation	20% coinsurance(authorization required)	40% coinsurance
Ambulatory surgical center	0%–20% coinsurance(authorization required)	40% coinsurance
Outpatient blood services	20% coinsurance(authorization required)	40% coinsurance
Skilled nursing and home health
Skilled nursing facility	Original Medicare cost-sharing(authorization required)	Original Medicare cost-sharing
Home health care	$0 copay(authorization required)	$0 copay
Kidney dialysis	20% coinsurance(authorization required)	20% coinsurance
Rehabilitation
Occupational therapy	20% coinsurance(authorization required)	30% coinsurance
Physical therapy and speech-language therapy	20% coinsurance(authorization required)	30% coinsurance
Cardiac rehabilitation	20% coinsurance(authorization required)	30% coinsurance
Pulmonary rehabilitation	20% coinsurance(authorization required)	30% coinsurance
Mental health and substance use
Inpatient psychiatric hospital stay	$1,830 per stay(authorization required)	$1,830 per stay
Outpatient mental health, individual session	0%–20% coinsurance(authorization required)	30% coinsurance
Outpatient mental health, group session	20% coinsurance(authorization required)	30% coinsurance
Psychiatrist, individual session	0%–20% coinsurance(authorization required)	30% coinsurance
Psychiatrist, group session	20% coinsurance(authorization required)	30% coinsurance
Partial hospitalization	$55 copay(authorization required)	30% coinsurance
Intensive outpatient program	$55 copay(authorization required)	30% coinsurance
Outpatient substance use, individual session	0%–20% coinsurance(authorization required)	30% coinsurance
Outpatient substance use, group session	20% coinsurance(authorization required)	30% coinsurance
Opioid treatment program	$0 copay(authorization required)	$0 copay
Ambulance and transportation
Ground ambulance	20% coinsurance(authorization required)	20% coinsurance
Air ambulance	20% coinsurance(authorization required)	20% coinsurance
Transportation to plan-approved locations	Not covered	—
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	20% coinsurance(authorization required)	20% coinsurance
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)	20% coinsurance
Medical supplies	20% coinsurance(authorization required)	20% coinsurance
Diabetes supplies	$0 copay(authorization required)	20% coinsurance
Diabetic therapeutic shoes or inserts	20% coinsurance(authorization required)	20% coinsurance
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	20% coinsurance(authorization required)	30% coinsurance
Routine chiropractic care	Not covered	—
Acupuncture	Not covered	—
Foot exams and treatment (Medicare-covered)	20% coinsurance(authorization required)	30% coinsurance
Routine foot care	$0 copay(authorization required, limits apply)	30% coinsurance
Dental?
Medicare-covered dental services	20% coinsurance(authorization required)	40% coinsurance
Preventive dental plan limit	$2,000 plan limit every year	—
Oral exams	$0 copay(limits apply)	$0 copay
Cleanings	$0 copay(limits apply)	$0 copay
Fluoride treatment	$0 copay(limits apply)	$0 copay
Dental x-rays	$0 copay(limits apply)	$0 copay
Other diagnostic dental services	$0 copay(limits apply)	$0 copay
Other preventive dental services	$0 copay(limits apply)	$0 copay
Restorative services (fillings, crowns)	$0 copay(authorization required, limits apply)	$0 copay
Endodontics (root canals)	$0 copay(authorization required, limits apply)	$0 copay
Periodontics (gum disease)	$0 copay(authorization required, limits apply)	$0 copay
Dentures and other removable prosthodontics	$0 copay(authorization required, limits apply)	$0 copay
Maxillofacial prosthetics	$0 copay(authorization required, limits apply)	$0 copay
Implants	Not covered	—
Bridges and other fixed prosthodontics	$0 copay(authorization required, limits apply)	$0 copay
Oral and maxillofacial surgery	$0 copay(authorization required, limits apply)	$0 copay
Orthodontics	Not covered	—
Adjunctive general services	$0 copay(authorization required, limits apply)	$0 copay
Vision?
Eye exam (Medicare-covered)	$0 copay(authorization required)	30% coinsurance
Routine eye exam	$0 copay(authorization required, limits apply)	30% coinsurance
Eyewear after cataract surgery (Medicare-covered)	$0 copay(limits apply)	40% coinsurance
Eyewear plan limit	$200 plan limit every year	—
Contact lenses	$0 copay(limits apply)	$0 copay
Eyeglasses (frames and lenses)	Not covered	—
Eyeglass lenses	$0 copay(limits apply)	$0 copay
Eyeglass frames	$0 copay(limits apply)	$0 copay
Eyewear upgrades	Not covered	—
Hearing?
Hearing exam (Medicare-covered)	20% coinsurance(authorization required)	30% coinsurance
Routine hearing exam	$0 copay(authorization required, limits apply)	30% coinsurance
Hearing aid fitting and evaluation	Not covered	—
Hearing aid plan limit	$2,200 plan limit every two years	—
Hearing aids (all types)	$0 copay(authorization required, limits apply)	$0 copay
Hearing aids, inner ear	Not covered	—
Hearing aids, outer ear	Not covered	—
Hearing aids, over the ear	Not covered	—
Medicare Part B drugs
Part B insulin	0%–20% coinsurance(authorization required, step therapy may apply)	20% coinsurance
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required, step therapy may apply)	20% coinsurance
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)	20% coinsurance
Other extra benefits?
Over-the-counter (OTC) allowance	Covered (allowance not stated)	—
Meals after a hospital stay or for a chronic condition	$0 copay(authorization required)	$0 copay
Fitness benefit	$0 copay	$0 copay
Health education	Not covered	—
Nutritional / dietary benefit	Not covered	—
Extra smoking and tobacco cessation counseling	Not covered	—
Enhanced disease management	Not covered	—
Telemonitoring	Not covered	—
Remote access technologies (web/phone, nurse line)	Not covered	—
Home and bathroom safety devices	$0 copay	$0 copay
Counseling services	Not covered	—
In-home safety assessment	Not covered	—
Personal emergency response system (PERS)	Not covered	—
Medical nutrition therapy	Not covered	—
Post-discharge in-home medication reconciliation	Not covered	—
Re-admission prevention	Not covered	—
Wigs for hair loss from chemotherapy	Not covered	—
Weight management programs	$0 copay	75% coinsurance
Alternative therapies	Not covered	—
Therapeutic massage	Not covered	—
Adult day health services	Not covered	—
Home-based palliative care	Not covered	—
In-home support services	$0 copay	75% coinsurance
Support for caregivers	$0 copay	75% coinsurance

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.

Drug tiers — preferred pharmacy, initial coverage

Tier	Cost-sharing
Tier 1	$0.00
Tier 2	25%
Tier 3	25%
Tier 4	25%
Tier 5	25%

Rx cost-sharing by coverage phase

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial deductible phase
Tier 1: Preferred Generic	$0.00	$0.00	n/a	$0.00	$0.00	$0.00
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	n/a	$0.00	$0.00	$0.00
Tier 2: Generic	25%	25%	n/a	25%	25%	25%
Tier 3: Preferred Brand	25%	25%	n/a	25%	25%	25%
Tier 4: Non-Preferred Drug	25%	25%	25%	n/a	n/a	n/a
Tier 5: Specialty Tier	25%	25%	25%	n/a	n/a	n/a
Catastrophic coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 3: Preferred Brand	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 4: Non-Preferred Drug	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 5: Specialty Tier	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00

Benefits in plain text

UHC Dual Complete WI-D001 (PPO D-SNP) (H0294-027-0) is a 2026 PPO D-SNP Medicare Advantage plan offered by UnitedHealthcare, available to residents of Lincoln County, WI.

The monthly premium is $9.00 (Part C and Part D together).

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.

Its in-network out-of-pocket maximum is $9,250.00.

The combined in- and out-of-network out-of-pocket maximum is $13,900.00.

The drug deductible is $615.00. Tier 1 exempt.

It is a special needs plan (Dual-eligible SNP).

The plan's formulary lists 3,609 drugs.

At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: 25%; tier 3: 25%; tier 4: 25%; tier 5: 25%.

CMS gives the plan's contract (H0294) an overall rating of 3.5 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.